§431:10A-601 - Reciprocal beneficiary family coverage defined; policyholder and employer responsibility for costs; availability.

[PART VI. MISCELLANEOUS PROVISIONS]

[§431:10A-601]  Reciprocal beneficiaryfamily coverage defined; policyholder and employer responsibility for costs;availability.  (a) Any other law to the contrary notwithstanding,reciprocal beneficiary family coverage, as defined in subsection (b), shall bemade available to reciprocal beneficiaries, as defined in chapter 572C, butonly to the extent that family coverage, as defined in section 431:10A-103, iscurrently available to individuals who are not reciprocal beneficiaries.

(b)  As used in this section, "reciprocalbeneficiary family coverage" means a policy that insures, originally orupon subsequent amendment, a reciprocal beneficiary who shall be deemed thepolicyholder, the other party to the policyholder's reciprocal beneficiaryrelationship registered pursuant to chapter 572C, and dependent children or anychild of any other person dependent upon either reciprocal beneficiary.

(c)  If a reciprocal beneficiary policyholderincurs additional costs or premiums, if any, by electing reciprocal beneficiaryfamily coverage under this section, the employer may pay additional costs orpremiums. [L 1997, c 383, §4; am L 2004, c 122, §37]

Attorney General Opinions

  Section applied only to insurers, and not mutual benefitsocieties or health maintenance organizations.  Att. Gen. Op. 97-5.

  As provided by subsection (c), an employer does not violatethe reciprocal beneficiaries act [L 1997, c 383] if it chooses not to pay anyadditional cost or premium incurred by the employee in electing reciprocalbeneficiary family coverage.  Att. Gen. Op. 97-10.

  Section applied to all parts of article 10A if the categoryof policy under consideration included family coverage, as defined in§431:10A-103.  Att. Gen. Op. 97-10.

  The division will be responsible for enforcement of healthinsurance provisions of the reciprocal beneficiaries act [L 1997, c 383]; thoseprovisions can only be enforced against insurers, not employers.  Att. Gen. Op.97-10.

  The employer is not required to pay the additional costsincurred by an employee's election for reciprocal beneficiary coverage.  Thefocus is on the insurance contract and the policyholder and recognizes that thereciprocal beneficiary, as policyholder, is the one who incurs the cost.  Att.Gen. Op. 97-10.

  The placement of this section in article 10A makes clear thatthe legislative intent was to mandate benefits that must be made available byinsurers that write contracts of insurance providing family coverage; moreover,the statute specifies that the coverage be made available to reciprocalbeneficiaries, not to employers.  Att. Gen. Op. 97-10.

  There is nothing in the reciprocal beneficiaries act [L 1997,c 383] that would prevent an insurer from making reciprocal beneficiary familycoverage available in a policy separate from the policy it uses to make regularfamily coverage available.  Att. Gen. Op. 97-10.

  To the extent that the reciprocal beneficiaries act [L 1997,c 383] does impose obligations on insurers, it may provide a basis for affectedpersons to seek relief by, for example, seeking declaratory relief underchapter 632.  Att. Gen. Op. 97-10.